Exhibit 2.6


                         AMENDMENT TO LETTER AGREEMENT


     This Amendment to Letter Agreement (this "Amendment") is effective as of 
December 4, 1997, by and among Green Spring Health Services, Inc., a Delaware 
corporation (the "Company") and Paul G. Shoffeitt ("You").


                             W I T N E S S E T H:
                             - - - - - - - - - -

     WHEREAS, you and the Company entered into that certain Letter Agreement 
dated February 3, 1994 (the "Letter Agreement");

     WHEREAS, the parties recognize that due to a current medical condition, 
you are unable to fully perform your duties under the Letter Agreement, and 
the parties therefore desire to amend the terms of the Letter Agreement as 
set forth herein;

     NOW, THEREFORE, in consideration of the mutual covenants and agreements 
set forth herein and other good and valuable consideration, the receipt and 
adequacy of which are hereby acknowledged, the parties hereto, intending to be 
legally bound, do hereby covenant and agree as follows:

1.   The introductory clause in Section 2 of the Letter Agreement is hereby 
amended to read as follows: "From February 3, 1994 until April 1, 2000 
(unless this Agreement is terminated earlier by you by giving fourteen (14) 
days written notice, or is terminated earlier by the Company in accordance 
with Section 5.2), you hereby agree to:"

2.   Section 5 is amended by redesignating such section as Section 5.1 
entitled "INDEPENDENT CONTRACTOR" and by deleting the second sentence from 
such Section 5.1.

3.   A new Section 5.2 is hereby added to the Agreement, to read in its 
entirety as follows:

     5.2 TERMINATION.
         -----------

(a)  TERMINATION DUE TO RESIGNATION AND TERMINATION WITH CAUSE.  Your 
     engagement under this Agreement and all of your rights to receive the 
     compensation set forth in Section 3 will cease upon the occurrence of 
     any of the following events: (i) the effective date of your resignation 
     (which you may provide at any time upon fourteen (14) days written 
     notice), or (ii) termination for cause at the discretion of the Company 
     under the following circumstances: (A) you are guilty of fraud or 
     dishonesty involving you duties on behalf of the Company; (B) you have 
     deliberately and intentionally failed or refused to faithfully and 
     diligently perform significant duties assigned to you pursuant to the 
     terms of this Agreement, or otherwise to have breached any material term 
     under this Agreement; (C) you have willfully failed or refused to abide 
     by the Company's





     policies, rules, procedures or directives; or (D) you are convicted of a 
     misdemeanor involving moral turpitude or any felony. For the events 
     described in clauses (ii)(B) and (ii)(C) of the preceding sentence, the 
     Company shall give you written notice of such event and an opportunity to 
     cure such circumstance for a period of thirty (30) days; provided, however,
     such opportunity to cure shall be given only once for the same or related 
     events arising from the same factual circumstances.

(b)  TERMINATION WITHOUT CAUSE. You and/or the Company may terminate this 
     Agreement without cause at any time upon the giving of thirty (30) days' 
     prior written notice to the other party. If the Company terminates 
     this Agreement under this Section 5.2(b), the Company may direct you to 
     immediately cease providing services. If the Company terminates this 
     Agreement under this Section 5.2(b), the Company shall continue to pay 
     you the compensation provided for pursuant to Section 3 of this 
     Agreement for the remaining balance of the period of engagement set 
     forth in Section 2 (without regard to such early termination) or for a 
     period of one (1) year from the effective termination date, whichever is 
     greater in length or time. No other compensation or benefits set forth 
     in Sections 3 and 4 of this Agreement shall be paid, unless otherwise 
     provided in the terms of the applicable plan or benefit.

(c)  DISABILITY. If you become Disabled, the Company may terminate this 
     Agreement at any time, and any such termination shall be deemed a 
     termination without cause under Section 5.2(b) above, and in the event 
     of such termination, you shall be entitled to all of the rights set 
     forth in Section 5.2(b) above. You shall be deemed Disabled if Employer 
     determines that you are, by reason of any physical or mental condition, 
     unable to perform a substantial portion of your essential duties on a 
     part-time basis pursuant to this Agreement.

(d)  EFFECT OF TERMINATION. Upon termination of this Agreement, all rights 
     and obligations under this Agreement shall cease except for the rights 
     and obligations under Sections 5.2(b), 5.2(c), 6 through 10, 12 through 
     13 and 17 through 23 of this Agreement, and all procedural and remedial 
     provisions of this Agreement. A termination of this Agreement shall 
     constitute a termination of your engagement with the Company for all 
     purposes of this Agreement.

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     IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be 
executed as of the day and year first written above.

Witness:

/s/ Illegible                                /s/ Paul G. Shoffeitt
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                                             Paul G. Shoffeitt

                                             COMPANY:
                                             Green Spring Health Services, Inc.

Attest:                                      By: /s/ Henry Harbin
                                                 -------------------------------
/s/ Illegible                                Name: Henry Harbin
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                                             Title: President
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